Motoko Kanno and Hiroyuki Kanao
Cervical cancer is the second most common malignancy in women, between the ages of 20 and 39, after breast cancer. The radical trachelectomy, developed by Daniel Dargent in 1987, is a treatment for early-stage cervical cancer in women who wish to preserve their fertility. There are few reports on pelvic peritonitis after a radical trachelectomy. Reports of Group A Streptococcus (GAS) infection in the field of gynecology are rare; and ascending vaginal infections have been reported in postpartum women, elderly women with low estrogen levels, and women after an uterine manipulation. In cases of severe peritonitis or endometritis, a hysterectomy might be required.
This is a case report of severe GAS pelvic peritonitis and pleurisy in a woman after a radical trachelectomy, who was not in a low estrogen state. Her condition improved temporarily with early antimicrobial treatment and drainage, but worsened again; following this, we performed a timely laparotomy with adequate cleansing and were able to preserve her uterus. Three and six months later with her follow-up appointment she was healthy and clear of infection. Women who have undergone a radical trachelectomy have a shorter cervix and potentially lower cervical defense mechanism than other women. If therapeutic intervention for severe pelvic peritonitis is delayed, then there is a possibility of losing the uterus. Obstetricians and gynecologists need to be aware of the possibility of GAS pelvic peritonitis in women who are not in a low estrogen state and should administer antimicrobial agents early. A laparotomy should be considered if there is poor improvement of symptoms.
